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The European Registry for Patients with Mechanical Circulatory Support (EUROMACS): third Paediatric (Paedi-EUROMACS)
Theo M M H de By1, Martin Schweiger2, Hina Hussain3
1EUROMACS, EACTS House, Windsor, United Kingdom.
Insights
The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) reports that while overall survival for paediatric mechanical circulatory support is high, younger children and lower-weight patients face significantly lower survival rates. Further research is needed to improve outcomes for these vulnerable groups.
Area of Science:
- Cardiology
- Pediatric Cardiac Surgery
- Biomedical Engineering
Background:
- The European Registry for Patients with Mechanical Circulatory Support (EUROMACS) collects data on durable mechanical circulatory support (MCS) in patients.
- Previous reports have focused on general MCS trends, with limited specific analysis of pediatric populations.
Purpose of the Study:
- To present the third pediatric report from EUROMACS, analyzing trends and outcomes in pediatric patients (<19 years) receiving mechanical circulatory support.
- To identify specific challenges and outcomes in younger and lower-weight pediatric patients requiring MCS.
Main Methods:
- Analysis of pre-, peri-, and long-term postoperative data for pediatric MCS implants (2000-2020) from 25 participating hospitals.
- Inclusion of patient characteristics, implant frequency, outcomes (mortality, transplant, recovery), and adverse events (neurological dysfunction, device malfunction, infection, bleeding).
Main Results:
- 537 implants in 480 pediatric patients were analyzed; cardiomyopathy was the most frequent etiology (59%).
- Overall 12-month survival was 79.2%. At 12 months, 45.1% received transplants, 7.5% were weaned, and 20.8% died.
- Survival was significantly lower in patients <1 year of age (P=0.01) and <20 kg (P=0.015).
Conclusions:
- Pediatric mechanical circulatory support shows high overall survival, but specific subgroups, particularly infants and low-weight children, experience poorer outcomes.
- Transplant rates at 6 months remain suboptimal at 33.2%.
- Continued efforts to improve compliance and participation in EUROMACS are essential for advancing pediatric MCS therapy.
Objectives:
A third paediatric report has been generated from the European Registry for Patients with Mechanical Circulatory Support (EUROMACS). The purpose of EUROMACS, which is operated by the European Association for Cardio-Thoracic Surgery, is to gather data related to durable mechanical circulatory support for scientific purposes and to publish reports with respect to the course of mechanical circulatory support therapy. Since the first report issued, efforts to increase compliance and participation have been extended. Additionally, the data provided the opportunity to analyse patients of younger age and lower weight.
Methods:
Participating hospitals contributed pre-, peri- and long-term postoperative data on mechanical circulatory support implants to the registry. Data for all implants in paediatric patients (<19 years of age) performed from 1 January 2000 to 31 December 2020 were analysed. This report includes updates of patient characteristics, implant frequency, outcome (including mortality rates, transplants and recovery rates) as well as adverse events including neurological dysfunction, device malfunction, major infection and bleeding.
Results:
Twenty-five hospitals contributed 537 registered implants in 480 patients. The most frequent aetiology of heart failure was any form of cardiomyopathy (59%), followed by congenital heart disease and myocarditis (15% and 14%, respectively). Competing outcomes analysis revealed that a total of 86% survived to transplant or recovery or are ongoing; at the 2-year follow-up examination, 21.9% died while on support. At 12 months, 45.1% received transplants, 7.5% were weaned from their device and 20.8% died. The 3-month adverse events rate was 1.59 per patient-year for device malfunction including pump exchange, 0.7 for major bleeding, 0.78 for major infection and 0.71 for neurological events.
Conclusions:
The overall survival rate was 79.2% at 12 months following ventricular assist device implant. The comparison of survival rates of the early and later eras shows no significant difference. A focus on specific subgroups showed that survival was less in patients of younger age (<1 year of age; P = 0.01) and lower weight (<20 kg; P = 0.015). Transplant rates at 6 months continue to be low (33.2%).
